Physiological and clinical relevance of anomalous right coronary artery originating from left sinus of Valsalva in adults

Sang Eun Lee, Cheol Woong Yu, Kyungil Park, Kyung Woo Park, Jung Won Suh, Young Seok Cho, Tae Jin Youn, In Ho Chae, Dong Ju Choi, Ho Jun Jang, Jin Shik Park, Sang Hoon Na, Hyo Soo Kim, Ki Bong Kim, Bon Kwon Koo

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11 Citations (Scopus)

Abstract

Objective: To examine physiological and clinical relevance of an anomalous right coronary artery originating from left sinus of Valsalva (right ACAOS) with interarterial course in adults. Methods and results: For physiological assessment, fractional flow reserve (FFR) during dobutamine challenge was measured in 37 consecutive adult patients with lone right ACAOS with interarterial course. At baseline, mean FFR was 0.91±0.06, declining to 0.89 ±0.06 upon dobutamine infusion ( p<0.001). Dobutamine stress FFR was significant (≤0.8) in three patients (8.1%), two of whom were surgically treated. Following surgery, dobutamine stress FFR rose from 0.76 to 0.94 and 0.76 to 0.98. Remodelling index (r=0.583, p=0.002), minimal lumen area (diastole: r=0.580, p=0.002; systole: r=0.0618, p<0.001) and per cent area stenosis (r=-0.550, p=0.004), measured by intravascular ultrasound, correlated with dobutamine stress FFR. To assess the clinical relevance, follow-up data of 119 patients with lone right ACAOS with interarterial course were analysed retrospectively. Two deaths occurred during a median follow-up period of 4 years, for a mortality rate of 0.34 per 100 person-year. No instances of myocardial infarction were recorded and one patient did undergo surgical revascularisation in the course follow-up. Conclusions: Most instances of lone right ACAOS with interarterial course discovered in adults were physiologically insignificant and ran benign clinical courses. Conservative management may thus suffice in this setting if no definitive signs of myocardial ischaemia are evident.

Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalHeart
Volume102
Issue number2
DOIs
Publication statusPublished - 2016 Jan 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lee, S. E., Yu, C. W., Park, K., Park, K. W., Suh, J. W., Cho, Y. S., Youn, T. J., Chae, I. H., Choi, D. J., Jang, H. J., Park, J. S., Na, S. H., Kim, H. S., Kim, K. B., & Koo, B. K. (2016). Physiological and clinical relevance of anomalous right coronary artery originating from left sinus of Valsalva in adults. Heart, 102(2), 114-119. https://doi.org/10.1136/heartjnl-2015-308488